Management of gastrointestinal side effects of cancer pharmacotherapy: Part 1: Diarrhoea, constipation, mucositis and anorexia
Authors:
Jan Juřica 1,2,3; Miroslav Turjap 4
Authors‘ workplace:
Farmakologický ústav, Lékařská fakulta, Masarykova univerzita, Brno
1; Ústav farmakologie a toxikologie, Farmaceutická fakulta, Masarykova univerzita Brno
2; Ústavní lékárna, Masarykův onkologický ústav, Brno
3; Oddělení klinické farmacie, lékárna FN Ostrava
4
Published in:
Čes. slov. Farm., 2024; 73, 222-227
Category:
Current Pharmacotherapy
doi:
https://doi.org/10.36290/csf.2024.040
Overview
Management of gastrointestinal side effects of cancer pharmacotherapy:
Part 1: Diarrhoea, constipation, mucositis and anorexia
Gastrointestinal side effects are common in cancer pharmacotherapy and may be facilitated by the disease itself. These adverse effects lead to reduced quality of life and may result in premature termination of therapy, which can adversely affect treatment outcomes. In extreme cases, adverse effects can even lead to patient death. This article reviews the main gastrointestinal side effects of anticancer drug therapy anticancer drug therapy in the context of solid tumor treatment and discusses the appropriate management and discusses the appropriate management of these complications. In the first part of this two-part article, we discuss diarrhoea, constipation, mucositis and anorexia.
Keywords:
diarrhoea – Chemotherapy – Constipation – mucositis – gastrointestinal adverse effects – anorexia.
Sources
1. Bacon CG, Giovannucci E, Testa M. The association of treatment-related symptoms with quality-of-life outcomes for localized prostate carcinoma patients: Cancer. 2002:94:862-871.
2. Kamath S, Nair KG. Clinical presentation and risk factors for chemotherapy-associated diarrhea, constipation, and intestinal perforation. In Drews, RE (Ed.), UpToDate. Available from https://www.uptodate.com/contents/clinical-presentation-and-risk-factors-for-chemotherapy-associated-diarrhea-constipation-and-intestinal-perforation. Cited 17. 9. 2024.
3. Common Terminology Criteria for Adverse Events (CTCAE). Available from https://ctep.cancer.gov/protocoldevelopment/electronic_applications/docs/CTCAE_v5_Quick_Reference_5x7.pdf Cited 17. 9. 2024.
4. Pessi MA, Zilembo N, Haspinger ER. Targeted therapy-induced diarrhea: A review of the literature, Critical reviews in oncology/hematology. 2014:90:165-179.
5. Bossi P, Antonuzzo A, Cherny NI. Diarrhoea in adult cancer patients: ESMO Clinical Practice Guidelines, Annals of oncology: official journal of the European Society for Medical Oncology. 2018:29:iv126-iv142.
6. Ozaka M, Nakachi K, Kobayashi, et al. A randomised phase II study of modified FOLFIRINOX versus gemcitabine plus nab-paclitaxel for locally advanced pancreatic cancer (JCOG1407). Eur J Cancer. 2023:181:135-144.
7. Conroy T, Bosset JF, Etienne PL, et al. Neoadjuvant chemotherapy with FOLFIRINOX and preoperative chemoradiotherapy for patients with locally advanced rectal cancer (UNICANCER-PRODIGE 23): a multicentre, randomised, open-label, phase 3 trial, Lancet Oncol. 2021:22:702-715.
8. Sharif S, O‘Connell MJ, Yothers G, Lopa S. Wolmark N. FOLFOX and FLOX regimens for the adjuvant treatment of resected stage II and III colon cancer. Cancer Invest. 2008:26:956-963.
9. Al-Batran SE, Homann N, Pauligk C, et al. Perioperative chemotherapy with fluorouracil plus leucovorin, oxaliplatin, and docetaxel versus fluorouracil or capecitabine plus cisplatin and epirubicin for locally advanced, resectable gastric or gastro-oesophageal junction adenocarcinoma (FLOT4): a randomised, phase 2/3 trial, Lancet. 2019:393:1948-1957.
10. Takei S, Kawazoe A, Jubashi A, et al. Safety and efficacy of perioperative FLOT regimen in Japanese patients with gastric, esophagogastric junction, or esophageal adenocarcinoma: a single-institution experience, ESMO Gastrointestinal Oncology. 2024:4:100050.
11. Paszt A, Simonka Z, Budai K, et al. Impact of neoadjuvant FLOT treatment of advanced gastric and gastroesophageal junction cancer following surgical therapy. Frontiers in Surgery. 2023:10:1148984.
12. Grover S, Wang Z, Dougan M. Immune checkpoint inhibitor colitis. In: Atkins MB (Ed.) Uptodate. Available from https://www.uptodate.com/contents/immune-checkpoint-inhibitor-colitis. Cited 17. 9. 2024.
13. Ikuno N, Soda H, Watanabe M. Irinotecan (CPT-11) and characteristic mucosal changes in the mouse ileum and cecum, Journal of the National Cancer Institute. 1995:87:1876-1883.
14. Osterlund P, Ruotsalainen T, Peuhkuri K. Lactose intolerance associated with adjuvant 5-fluorouracil-based chemotherapy for colorectal cancer, Clinical gastroenterology and hepatology: the official clinical practice journal of the American Gastroenterological Association. 2004:2:696-703.
15. Groenland SL, van Eerden RAG, Westerdijk K. Therapeutic drug monitoring-based precision dosing of oral targeted therapies in oncology: a prospective multicenter study, Annals of oncology: official journal of the European Society for Medical Oncology. 2022:33:1071-1082.
16. Macaron C. Management of acute chemotherapy-related diarrhea. In: In Drews, RE (Ed.), UpToDate. Available from: https://www.uptodate.com/contents/management-of-acute-chemotherapy-related-diarrhea Cited 17. 9. 2024.
17. Irinotecan (conventional): Drug information. in: Uptodate. Available from https://www.uptodate.com/contents/irinotecan-conventional-drug-information. Cited 17. 9. 2024.
18. Alpelisib: Drug information. In: Uptodate. Available from https://www.uptodate.com/contents/alpelisib-drug. Cited 17. 9. 2024.
19. Larkin PJ, Cherny NI, La Carpia D, et al. Diagnosis, assessment and management of constipation in advanced cancer: ESMO Clinical Practice Guidelines, Annals of oncology : official journal of the European Society for Medical Oncology. 2018: 29:iv111-iv125.
20. Lee EQ. Overview of neurologic complications of conventional non-platinum cancer chemotherapy. In: Wen, PY (ed.) UpToDate. Available from https://www.uptodate.com/contents/overview-of-neurologic-complications-of-conventional-non-platinum-cancer-chemotherapy. Cited 17. 9. 2024.
21. Vincristine (conventional): Drug information. In: Uptodate. Available from https://www.uptodate.com/contents/vincristine-conventional-drug-information. Cited 17. 9. 2024.
22. UpToDate. Thalidomide: Drug information. Drews, RE (Ed.), UpToDate. 2024. Available from https://www.uptodate.com/contents/thalidomide-drug-information?search=thalidomid & source=panel_search_result & selectedTitle=1%7E150 & usage_type=panel & kp_tab=drug_general & display_rank=1.
23. Dimopoulos M, Spencer A, Attal M. Lenalidomide plus dexamethasone for relapsed or refractory multiple myeloma, The New England journal of medicine. 2007:357:2123-2132.
24. Vokurka S. Péče o dutinu ústní u onkologických pacientů. Dialog Jesenius. 2015. ISBN: 978-80-905986-1-4. Available from http://www.mukozitida.cz/files/SkriptaMUKOZITIDA_web.pdf. Cited 17. 9. 2024.
25. Negrin RS, Treister NS. Oral toxicity associated with systemic anticancer therapy. In Drews, RE (Ed.), UpToDate. Available from https://www.uptodate.com/contents/oral-toxicity-associated-with-systemic-anticancer-therapy. Cited 17. 9. 2024.
26. Martins F, de Oliveira MA, Wang Q, et al. A review of oral toxicity associated with mTOR inhibitor therapy in cancer patients, Oral oncology. 2013:49:293-298.
27. Watters A, Epstein J, Agulnik M. Oral complications of targeted cancer therapies: a narrative literature review, Oral oncology. 2011; 47:441-448.
28. Negrin RNT. Oral toxicity associated with systemic anticancer therapy. In: UpToDate, editor; 2024. Available from: https://www.uptodate.com/contents/oral-toxicity-associated-with-systemic-anticancer-therapy?search=Oral%20toxicity%20associated%20with%20systemic%20anticancer%20therapy & source=search_result & selectedTitle=1%7E150 & usage_type=default & display_rank=1.
29. Yuan A, Kurtz SL, Barysauskas CM, et al. S. Oral adverse events in cancer patients treated with VEGFR-directed multitargeted tyrosine kinase inhibitors, Oral Oncol. 2015:51:1026-1033.
30. Peterson D, Boers-Doets C, Bensadoun R, Herrstedt J. Management of oral and gastrointestinal mucosal injury: ESMO Clinical Practice Guidelines for diagnosis, treatment, and follow-up. Annals of Oncology. 2015:26:v139-v151.
31. Elad S, Cheng KKF, Lalla R. V. MASCC/ISOO clinical practice guidelines for the management of mucositis secondary to cancer therapy. Cancer. 2020:126:4423-4431.
32. Roeland EJ, Bohlke K, Baracos VE. Cancer Cachexia: ASCO Guideline Rapid Recommendation Update, Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2023:41:4178-4179.
33. Jatoi A. The role of parenteral and enteral/oral nutritional support in patients with cancer. In: Hesketh PJ (ed.), Uptodate. Available from https://www.uptodate.com/contents/the-role-of-parenteral-and-enteral-oral-nutritional-support-in-patients-with-cancer. Cited 17. 9. 2024.
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